Your Gut Keeps Its Own Age, and It Can Get Younger

Welcome back again to another great episode. I have here an amazing guest. We're going to talk about a lot of interesting things you never heard of, how your gut bacteria actually might affect hormones, particularly during menopause and perimenopause. So after a brief introduction, we're going to hop into today's amazing conversation. What if your gut has its own age? And what if, as you get older, younger, That number actually is not based on your birth date, but actually your gut influences. And what if you can actually measure it and then eventually change it or turn it back? My guest today, Dr. Julia Mokowitsky, I'm sorry, will answer that question for us. Dr. Julia is a naturopathic doctor and doctor of chiropractic medicine with a background in biomedical science. She serves as a clinical educator at Doctor's Data and is one of the field's leading functional, which is one of the field's leading functional laboratories. She runs her own functional medicine practice as well outside of Chicago. She's a researcher, international educator on the gut microbiome, and she's recently co-authored a new work examining how the gut bacteria shift across age of different areas in the world actually is important. That was one of the lectures actually I heard her talking about this past year at the A4M conference, which is one of the reasons why we invited her to the podcast. Really, really cool stuff. She's also a frequent speaker throughout the country at the A4M, at the American Academy of Anti-Aging and Regenerative Medicine. And just a world-renowned expert in the field. So welcome to today's podcast.

Thank you so much, Dr. Hartman. It is a pleasure to be here.

Now, um, a little bit, you're, you're, um, a lot of my audience is not going to be familiar with you and your work. So could you give us a brief overview of like what, what got you first into medicine and how you got down this pathway of like age, gut, gut microbiome, like hormones, this, this kind of stuff that I think is really cutting edge right now.

Yeah, absolutely. So like many of us in this field, It began as a personal quest. So, I'd always been interested in medicine, family history of metabolic disease, obesity that really seemed to be environmentally influenced. And so, that was something that I grew up with considering that dynamic there. And then, when my beautiful baby boy was born, he was born very healthy, but unfortunately had terrible skin rash that would not resolve. And he had an excellent pediatrician. He still is an excellent pediatrician, but he just attributed this to potentially detergent or something that we brushed up against, not underlying root mechanism cause. And so I was able to reach out to a naturopathic doctor and elucidate the factor there was actually lactose intolerance. And once we eliminated lactose from the diet, everything cleared up. She said it would go away within 1 week. It went— excuse me, she said 2 weeks. And after eliminating dairy, it went away in 1 week. And so that was miraculous to me. I'm sure your listeners agree that having a healthy child is so important and such a blessing. So to me, that changed the trajectory of my life. I was a nanny at that time and I completely switched my career to naturopathic medicine, actually.

So it's really interesting how many people get into this field. I actually don't think I've talked to anybody yet who doesn't have either a personal or a family member story that got them off the, whatever their traditional path was. Even career field changes into this field that is blowing up right now. It's super popular, but it's not the typical, it's not the normal, it's the path not taken. And so, on that note, even people who get in this world go down different pathways. And why don't you talk to us about this one thing you mentioned, this idea of biome aging. that aging is not just our skin aging, our hormones. It's actually the bacteria in and on our body affecting the aging process. You know, is this the chicken or the egg thing? Does our biome change first? Could you talk a little bit about that concept of our microbiome aging?

And then, yeah, absolutely. Well, your gut does have its own biological clock. And as we dive into functional medicine, you can only get so long before you arrive at the gut, because the father of medicine, Hippocrates, he stated all disease begins in the gut. And with modern medicine, we're really understanding this connection between the gut microbiome and our health, our physiology. So biome aging is essentially the age of your gut microbiome and its influence over the downstream factors such as transformations in physiology. So the gut microbiome itself, it's not a passive bystander in the process of aging, but it's directly influencing other factors of our physiology.

And so how does that relate with like inflammaging? Because that's like a very popular term right now, or even telomere length. Like, you know, I thought they determined, you know, telomeres were the end-all be-all for our aging. Like, how does that fit in with telomeres and inflammaging? And then this biome aging, are they— we look at the same elephant from different ways. Are these totally unrelated? Are they—

So again, it goes back to the gut because actually telomere length is downstream of the gut microbiome age. So telomere length is a very popular biomarker. It is a relevant biomarker, but the correlation with chronological age is actually varies, especially across different labs, different tissues. There's inter-individual differences. So that would not be a biomarker that I would hang my hat on clinically, especially when compared to gut microbiome age. Because gut microbiome age is modifiable. So in clinical practice, we're thinking about not necessarily correlating, collecting data. We're thinking about how can this information help our patients and what can we do to influence their health outcomes. So gut microbiome dysfunction does track with biological age and methylated biological age clocks. So they have actually studied gut microbiome aging. And this correlates with the epigenetic clocks, such as the Horvath clock, the DunedinPACE clock. So, some phenol age clocks that you may be using in your clinic, they actually do correlate with gut microbiome aging.

Is there right now, and this is a question for me, is there a test right now if you were to do a gut microbiome evaluation that actually, because I've seen that in books and in different lectures, like the picture of like young kid, with a microbiome and lots of, you know, Bacteroidetes, and the old person who has like low diversity. Is there actually a test that actually gives you a spectrum, and based on your gut test set, gives you an age?

Well, so gut microbiome age is— gut microbiome diversity is associated with age because it does decrease as we age. So, across our lifespan, we want to have a healthy, diverse microbiome. And exactly as you're mentioning, Children have really robust microbiomes, and you mentioned inflammaging, that's layered on into this because inflammaging is essentially the compounding effects of our physiology, the impacts of chronic low-grade inflammation over time due to modern life, essentially. So with healthy children, you really have this healthy, robust, beautiful microbiome. It's very diverse, has excellent abundance. But then when we're exposed to different environmental factors, that tends to decrease as we age. And we talked a little bit about perimenopause. That's a specific shift as well. And so that's just something we do want to take a data point of, is understanding microbiome diversity and maintaining diversity. The higher, the better, essentially.

Is there any association with diversity? And because I'm in my career right now, I'm dealing with a lot of Um, I don't, my wife, you know, don't we, the age, the middle-aged women, right? People that are kind of going through the change of life. I'm not sure what the correct term is these days, but they're going through that. And some women, the hormone changes are horrible. Some women it's like, eh, it's not so bad. Um, is there an association with this gut diversity and women's ability to go through that transition in a better way, or even in like how much hormones they need when they're in menopause that make them optimal? Is there some, is there some relationship there?

So when we're talking about estrogen, The gut microbiome is integral to many factors, but estrogen metabolism is chief among them. And so we want healthy microbiome diversity to facilitate optimal estrogen metabolism. And it can really go one of two ways because we have the estrobolome in the gut microbiome, and that's really responsible for clearing conjugated estrogens. Chief within that system is beta-glucuronidase. If there is elevated beta-glucuronidase, this can actually be contributing to a decreased clearance of estrogen. And so, this is just one factor in this system. So, we have the estrobolome, we have decreasing microbiome diversity, which I'm going to layer on now what we talked about. Microbiome diversity is actually anti-inflammatory. So, when we have disturbances in the gut microbiome, we have decreasing diversity, and then we always also have— excuse me— increases in in systemic inflammation. And we'll layer in one more factor here, the mucosal barrier. So mucosal barrier is an aspect of the gut that implicates— it's not just a gut issue, it implicates cardiometabolic health. It's very important actually for estrogen balance and bacteria such as Akkermansia. So when we have these shifts, we have a combination of multiple factors that really change the gut microbiome. And then, that leads the way downstream for other factors associated with the gut microbiome. Like, we see changes in lipid metabolism in menopause, right? So, these are all connected.

What kind of changes will you see in lipid metabolism in menopause? Like, what, you know, if a female's going through perimenopause, you know, postmenopause, like, what What is the typical thing you'd expect to see as far as LDL, HDL, triglycerides, insulin resistance? Like what biomarkers would I expect to see in a typical female going through this?

We do see the metabolic syndromes. So, the metabolic changes, excuse me. So, increases in LDL, decreases in HDL, and some increases in oxidized LDL. So, that is associated with, again, that slight change in inflammation. Within the gut microbiome, it also has to do with fiber. So when we have a healthy fiber diet, it helps to balance the cholesterol. And so this is very important to consider fiber to feed the gut microbiome during the perimenopause and menopausal change of life.

One thing I've noticed, and I kind of actually, it's so funny how much I learn from my patients who will say, hey, I went to this blog and I remember microdosing with GLP-1s maybe 3 years ago. I've been using GLP-1s since about 2005 or '06 in my medical practice. And so one of them was like, hey, I heard about this thing. I'm like, that's the dumbest thing ever. I mean, oh my gosh, like who's going to do that? Sure, whatever, we'll try it. And then all of a sudden in the mast cell world, you hear, hey, microdosing is helping with POTS, dysautonomia, chronic fatigue, fibro. And over the last 2 years, I've seen some pretty crazy responses. And in my women, the point of that is in my women going through this change, some women, particularly my type A, who are like, go, go, go, go. Like, you know, I'm sleeping five hours a night. I'm you know running this business, that thing, kids, da da da. And they go through menopause; they crash out. And when I start replacing the hormones, it's like really hard. It's like I'm dealing with cortisol. And that in that group of women, the GLP ones have been this crazy tonic that's made like it's almost like it's made. I don't know what it's doing as far as like, I theorize mast cell inflammation and kind of stuff. But one, could you speak to like the whole GLP-1 thing here, which is very popular related to the gut microbiome and the change with perimenopause and the microbiome as well? Because I feel like that's something that's super fascinating that I'm seeing clinically, but I want to put like a, you know, a pin in it. Like what exactly is going on?

Yeah, that's a great observation. And I absolutely see that in practice as well. So GLP-1 is glucagon-like peptide, and it is actually secreted from the gut microbiome in the presence of specific bacteria, including Akkermansia and Bifidobacterium, under the conditions of colonic distension. So when we feed our colon properly and we have adequate fiber, especially soluble and insoluble fiber, that combination there, it signals our intestinal cells to expand and distend. So the combination of the mechanoreceptors, as well as the bacteria help the body to signal in the presence of right food and satiety, the secretion of that GLP-1. And so that goes on to stimulate the hypothalamus and goes on to decrease considerations such as hunger, increasing feelings of satiety, et cetera. But at the same time, we know it does influence insulin. And so what we do see over time is this— Moderation of inflammation. Instead of with modern life and general food that we eat, we're having such variations in glucose and insulin spikes. With the GLP-1 over a long time, we're really moderating that. And so, we're giving our body a clear signal. I do theorize that this is associated with the fact that we're seeing lower incidence of dementia and lower incidence of cardiovascular disease. Long term with these patients because we're counteracting that inflammation that we've been discussing, right? And GLP-1s are so popular and for good reason, but it makes me think about a few things, right? So are we deficient in in this peptide as a population, right? Or is this associated with some changes that we're observing with the gut microbiome that we have? You know, over time, essentially.

Yeah. I just finished a certification thing through USF in personalized medicine. And I remember early on, I started that 2 years ago. One of the slide lectures was looking at GLP-1's dose pharmacologically, and they're super high. Like, they're like 10, 15 times our physiologic doses. So, even with the microdosing, you're still getting a super physiologic dose. So, you know, to your point is that deficiency or is it a resistance or is it because these doses are more than you expect the body to produce? We're actually like, you know, it's a supraphysiologic, you know, pharmaceutical kind of thing. And if that's the case, is that long-term, do you still see the benefit? Does it wear off or does it abdicate our need to do all these other things?

Yeah. And it's interesting, the endogenously produced GLP-1 does have a half-life. Of 2 minutes, uh, versus the pharmaceutical has a half-life of 1 week. So that's the 1-week dose there. So in terms of, um, so it is interesting to, I mean, there's all different ways you can think about it, but it does benefit physiology essentially, especially at those microdoses, especially the dose matters, of course. Um, now one thing I will just mention since we're talking about it is there's a lot of education about feeding the gut micro— excuse me, feeding protein to support muscle during your GLP-1 journey. But I do strongly advocate to feed your gut microbiome during the GLP-1 journey because what will happen is if patients aren't eating and they're deficient in fiber, they're deficient in polyphenols, what will happen is starvation of beneficial bacteria like Akkermansia and bifido and lactobacillus. Once these bacteria starve, they will decrease in abundance. Essentially, they're going to die because we need to feed them to keep them living in our microbiome. And that's going to shift the microbiome to dysbiosis, to loss of diversity, which is going to be a pro-inflammatory microbiome. And you don't want to be counteracting that anti-inflammatory GLP-1 with an inflammatory state in the microbiome.

Do we know if taking GLP-1s actually change the microbiome? Great question.

So, there is some evidence that the GLP-1 itself itself actually is beneficial to the microbiome and specifically to Akkermansia muciniphila, which is a keystone bacteria that's very popular right now. But what I can tell you is in reviewing many, many gut microbiomes under the influence of GLP-1, it is diet dependent.

Okay. Now, you did mention this idea of keystone species, which I think that concept was really Kind of a cool concept because it's, you'll have people come in and you're looking at, you know, 100 trillion bacteria and I'm going to give you my fancy probiotic with like 5 bacteria. And while you feel better, it doesn't seem like it kind of makes sense. But once you understand the concept of keystone species, it makes sense how a few things can have a big impact. So could you like unwrap that for us? Like, what does that mean? What are the keystone species and what can you do to actually improve them if they're that important?

So not all bacteria are created equal. There is an algorithm essentially to this bacteria. If you think of them as a symphony, you need all of the instruments playing, but some of them are contributing greater than maybe the tambourine in the background. So the keystone bacteria are bacteria such as Bifidobacterium, Lactobacillus, Faecalibacterium prautnitzii. And I would say another one that we find is kind of punches over its weight is Akkermansia muciniphila. It's not as abundant as the others, but it's really integral to the mucosal barrier. And so that's really important for health outcomes. So for these bacteria, of course, we can evaluate them in a gut microbiome test and see exactly where they are in terms of their levels. You can, like you mentioned, support these through probiotics, especially lacto and bifido. But Faecalibacterium prausnitzii doesn't have a probiotic now. Akkermansia is now newly available as a probiotic. But we can also think about what feeds these bacteria, right? So Lactobacillus really likes polyphenols. Bifido really likes polyphenols. Faecalibacterium prausnitzii really likes soluble fiber. So it's important to do that. And then once these bacteria all work together exactly like a symphony, and so when we have higher levels of bifido, that actually supports levels of Akkermansia because bifido ferments the food that we eat, creates the short-chain fatty acids, and those go on to regulate and feed the Akkermansia. So the good thing is that these all work in consort. And so once we start to support something here or there, it can have positive effects on the rest of the ecosystem.

So we're looking at, you know, going back to my question initially, looking at your age of your microbiome, what your gut age. It sounds like there's like some big factors, maybe, you know, telomere length. I've always had questions about the clinical validity of that just because, you know, just because there's, you know, the shark that lived to be 500 years or whatever, that has like tons of telomeres doesn't necessarily correlate with human longevity. What would be the major markers of, if I'm doing a gut test on someone or someone got one done online, they're looking at it and they don't, I don't know what this means. You know, what are like the major markers you look at to give you an idea of The age of someone's gut microbiome?

So if I had to use one biomarker, I would say microbiome diversity. So microbiome diversity, we know that it actually maintains in centenarians. We do see it decrease significantly as we age, but then significantly past the age of 70. And again, in those perimenopausal women, that's a— perimenopause is actually a key time, I would say, to take a look at the gut microbiome and see and influence it for positive outcomes. Predictable through the next decade, right? So we know during the first 2 years of life, the gut microbiome is developing. This is a key window. The gut microbiome is actually like an ecosystem. So in ecology, when you plant the seeds in a barren landscape, it really lays the foundation for the future of that ecosystem. The gut microbiome is the same in that when we are laying the foundation in the first 3 years of life, This gives us factors that actually influence the microbiome for decades to come. And then perimenopause is another transition period because we have hormonal fluctuations, et cetera. So we really want to maintain microbiome diversity at that time to improve health outcomes for, you know, decades to come, but also in the immediate future. So microbiome diversity is a key biomarker. I would also look at Akkermansia muciniphila because of its implications with regards to mucosal barrier integrity, metabolic syndrome, Like we've been discussing. And then also bifido is really important as well. Those would be the main things to look at. Of course though, I'm talking about a healthy gut. If your patient has gut microbiome dysbiosis, you definitely want to identify that immediately and address it.

So, shoot, I had wrote this question down, circled. Oh yeah, testing. That was my question. So I've noticed, you know, I've had seen this happen with patients as well as myself. I'm sorry, we were talking, all these questions pop in my head and I write little things down and I circle them and then I go back and what was that? What was that? Testing the box. What did that mean? Um, so yeah, personally I noticed, I noticed with patients, like I'll do the microbiome test and it shows low diversity and no Akkermansia or low pain grasp elastase or whatever the markers are. I started doing things, they feel better. Then you test it again. And it doesn't look like that much more amazing. Like, it's kind of hard because people start and stop things and their diet changes. Like repeat testing, you know, the way I've kind of evolved in it is like, I feel like it gives me like your baseline. Like if I do nothing, it's going to go back to this, but I'm really pushing a boulder uphill and really to keep it going up, I need to keep on pushing it. And if you're not testing when you're pushing, you're going to keep, you're going to get what it rolls back to. Is that a— way of thinking about it? Or how would you think about repeat testing in individuals with, with maybe they're healthy or maybe not, but like, as far as like making sure we're maintaining a healthy microbiome for people's health? Yes.

So there's a few different ways to think about it. And, you know, acute conditions are fairly straightforward. So if you have a pathogen, if you have a fungal infection, I mean, those are pretty fairly straightforward with regards to that inherent composition of the gut microbiome that does take longer to improve exactly as you're mentioning, because it goes back to That baseline, as you're saying, as you're saying. So that's something to really keep an eye on and monitor it. In some patients, the education and the empowerment of the lab report is excellent. So you can test those patients maybe 12 weeks. But then in other patients, maybe like you're saying, once a year, every 6 months, just to maintain, to see, to garner a little bit of insight into the data point. Yeah.

Yeah, it's, it's interesting. Personally, I just, I've found that when I test, I need to be doing all the stuff to keep everything doing amazing. And then I'm usually not testing when I feel great. That's usually like you fall off the bandwagon. Now let me see what's going on. It's like, it looks the same. It's like, I didn't check it. Everything was doing great. You know?

Yeah.

Um, so leaky gut, zonulin, you know, um, that's something we have not even talked about at all. I feel like, you know, people are aware of leaky gut, zonulin. Where does, what does leaky gut relate, you know, what is zonulin and where does that fit into all of this? Okay.

I'm glad you asked this because intestinal barrier is equally important to gut microbiome when we're talking about the impacts of health and longevity. So it doesn't get as much press as gut microbiome, but it's really important. So zonulin is a protein that regulates intestinal permeability and it modulates those intracellular tight junctions. And this is a biomarker that we can assess to understand the the process of that tight junction. And so essentially, intestinal barrier is a dynamic system. Our body is constantly sampling the luminal contents to see if there's something there that we need to make an immune response to. Right? So the gut microbiome is very important because this is the first part of physiology. Where our body meets our internal physiology environment meets the external environment. And so we're constantly monitoring that. And that is where tight junction permeability comes in because it's a dynamic system. It's inherent to basically our immune system and the homeostasis. So zonulin is a marker of this process. Now we know that Intestinal barrier dysfunction actually increases as we age. It actually increases in the presence of stress. And so, who amongst us is not stressed and aging, right? So, this is a factor.

So, let me talk about peptides really briefly, which GLP-1 is a peptide, but there are certain peptides that actually can be helpful with this process that I've had great results with. Um, can you briefly talk about, you know, well, people, I think most, most people know that GLP-1 is a peptide, but what are peptides and, and how can they be helpful with this whole process? Because sometimes I, sometimes I feel like people need like a little extra push clinically to get over the hump. And I've had pretty good results with certain, um, oral and injectable peptides as well.

Yeah. So they are small, essentially fragments of proteins. Um, and you may be the expert in that one. I don't know if you're thinking about KPV for For the gut, or is there—

Well, once we— well, think about BPC, um, KPB, and even, um, TB500, TB4, TA1, depending on what's going on. Um, I have a Crohn's patient right now who is in 100% remission, and I just learned— I know this is old information, but I learned like 3 weeks ago that you could— they're actually studying BPC to treat Crohn's. I'm like, I wonder if that's what I was doing the last couple years.

I should just do it earlier. Awesome. So can I ask you, because, um, Oral or the injected, uh, BPC-157 in that case? Have you noticed a difference?

Okay. I'm using oral on BPC. Now I've noticed a difference with different vendors. Some vendors, like, you'll, because I've been forced to find new vendors and I'm in Virginia and, um, our state's been very unfriendly to the whole peptide thing. So we've had, I've had to switch vendors. I've got a new one that's pretty good now, but it's interesting. You switch vendor and all of a sudden the people, oh my God, it's not as good. So I've noticed there is like Definitely a quality difference between different oral peptides. But, you know, when dealing with the gut, I tend to use the oral ones, you know, anywhere from once to 4 times a day of the 500 microgram BPC. And then, KPV obviously has some really cool— and you've mentioned that, you know, maybe you want to talk a little more about that as far as gut stuff. And then, there's a few other ones I use as well, depending on what else is going on, if someone actually has an autoimmune disease or not.

Yeah, that's very interesting. Yeah, I'm currently not using peptides in my practice. I'm researching them with regards to mechanism of action, but I haven't used them yet. So that's very interesting. Yeah.

You know, with a lot of my mast cell patients or my food allergy or reactivity patients, some of those BPC-157 with the KPV, it's like, it's almost like a little magic pill sometimes. I don't want to say that, but sometimes I do. The KPV actually acts as well sometimes as an antimicrobial peptide. It helps balance out the microbiome as well as heal with some of the issues with the tight junction. So they're a really nice combination that you can take by mouth, minimal side effects, if any. And it's a pretty, got a pretty big therapeutic range as well.

That's awesome. Yeah. I mean, we do need to provide our patients with the molecules to really support their physiology. So that's reassuring to hear that you've had that success.

So now something else I, you know, you've talked about with, and this is something that I feel like is a big deal that maybe it fell off the radar, is the idea of like environmental chemicals, toxins, and their impact on the gut microbiome. Because we're like, oh, I'll eat some clean food, but then you're spraying your house with XYZ chemicals. You're doing whatever. Like, how do they play into this whole idea of your gut inflammation, aging stuff? And where are the big players people, the biggest players people should look out for to stay away from or avoid?

Yeah. So unfortunately modern, modern life is actually a risk to the health of our gut microbiome. So we are familiar with glyphosate. Glyphosate is very popular in all kinds of foods from cereals. I mean, it's in almost everything. And that is a precursor to intestinal barrier dysfunction. Additionally, emulsifiers and artificial sweeteners, those actually cause intestinal barrier dysfunction. So we do have additives and just everyday foods that most people are eating without even thinking twice. Do change the gut microbiome. So unfortunately that leads to metabolic, once we have the loss of mucosal barrier integrity and intestinal permeability, we do have downstream effects of systemic inflammation and metabolic changes. So there is a direct connection there between, I would say, the standard American diet and the increase in chronic disease and metabolic syndrome.

Yeah, it's, um, I, you know, when I was doing some research years ago, just seeing like there's actually certain bread conditioners, emulsifiers that are related with inflammatory bowel disease. And then it's also okay, is what's the problem with bread? Is it, is it, is it the, is it the bread thing itself? Is it that we emulsify process? Is it that we use a monoculture, not a polyculture? Is it that we do a chemical? It's like, it gets kind of complicated, but even with, you mentioned some chemicals, like I think it's 92, maybe percent of glyphosate, of Roundup's inactive ingredients are basically petroleum distillates, which are 100% horrible for your microbiome. So, I think just cleaning our environments up, cleaning our food up is a big, a big player. And the emulsifier thing is just, it's, it's everything. It's kind of hard not to get a packaged box food that doesn't have some kind of—

Exactly. We have to basically eat whole foods, eat real foods, and focus on feeding the gut microbiome. The next thing that's going to be interesting to see, I believe, is the nanoplastics, because we're already seeing those in atherosclerotic plaques. So, I'm interested to see the research on that with the gut microbiome.

Yeah, nanoplastics, a little crazy. I was actually— one of my colleagues, he's a urologist in Florida, and he was talking about males with infertility, doing biopsy on the testicles, finding nanoplastics in the testicles. And I'm just like, wow. Ooh, I'm like, yeah, non-plastic. But it's, if it gets in a male's testicles, is it getting ovaries? Is it getting in the uteri? Is it, is it, is it having crazy, you know, what do you do? What with nanoplastics, what's your understanding of how they affect the females?

You know, that's a good question. I haven't dove into that yet. Uh, have you seen some research about that specifically?

Well, it's about the, what I've seen mainly is related to like the bisphenols A, B, S, the Like, because a lot of these chemicals actually have estrogenic activity. So, it's more related to their, their, their, the bisphenols, their estrogen-like activity that's dysfunctional. But as far as the nanoplastic thing, I'm not going down the pathway of like, what's toxic about the nanoplastics? Is it like, are they, are they by themselves causing problems or is it they have these other estrogenic chemical response? Or is it just they cause like a local adjuvant response, which is one of the big issues with petroleum products? People forget that the original vaccines were used, Freund's adjuvant, which was a petroleum distillate. And so is some of this immune dysregulation literally the petroleum distillates?

Yeah.

Like with the colors acting like adjuvants, which trigger our immune system that cause inflammation. So that, I feel like there's a, there's a, there's a big elephant in the room with just with that whole idea of adjuvanting products in our air, water, food causing I mean, just regulation, that's by itself a really fascinating concept.

Yeah. Unfortunately, I think it's going to be a factor of all 3 mechanisms of action there, genuinely.

Yeah. Now, so one of the things that when I was researching some stuff that you've been doing, that you've done some cohortism research with, I'm really fascinated with the idea of the microbiome across different cultures, North America, Europe, Australia. Could you talk to that? Because I really, I dove in years ago into the Weston A. Price stuff and then Sir Albert Howard stuff, which is the whole idea of different cultures and That whole thing really fascinates me. Could you just kind of tell us what some of the stuff was around and what you learned?

Yeah. So during that study, we actually analyzed over 3,600 stool samples across America, North America, Europe, uh, Canada, and Australia. What we did find with that study is that the UK and Denmark, so the European cohorts had lower dysbiosis scores. Uh, their score was lower than it was the lowest. And then North America and Canada were second. Highest. Australia actually and Canada were tied for the highest dysbiosis index. So we do see that with regards to the food items, and it goes back to what we said earlier about the additives and the emulsifiers. So we know that the food in the US is not created equal to the food in Europe. I'm sure you have many patients that can travel to Europe and they can eat the pasta and the bread and feel completely fine. And not so much in, in the United States. So we did see that reflected in this study actually.

Oh, interesting. What with Denmark and the UK, like, did you find anything specifically or what do you, what's your theory? I always have theories about stuff, right? The more you read, the more theories you have, right? About why Denmark and the UK, why do they have the least amount of—

Yeah. My theory is the diet and the food additives. Um, and then in Australia, I think it has to do with the meat intake. So, depending on meat and protein with regards to the gut microbiome, we do need to balance it with fiber. So, that's a whole other thing we could talk about is meat-only diets and dysbiosis. But, so I do think it has to do with the lack of additives and the whole food compared to, of course, North America and some of the meat influence in Australia.

Yeah, I think something like 80% of what Americans eat is processed. So it's like, and 60% ultra-processed, which means it's not even like, it's a food-like product, like Velveeta or whatever. So it's kind of like, I was actually surprised that, um, we weren't at the top of that, that we were actually not, not as, not the worst. Um, I was expecting you to tell me America's the worst of all, not, not Australia, you know? It's kind of a little spot on.

And then the other thing is, I will say, uh, another study, not my study, was able to find that when Individuals immigrate to the United States that they have a decrease in microbiome diversity that subsequently increases with each generation born into the US. So, it certainly is our environment and our food, I would say, that really does.

So, there's a generational— because I've had this— one of the things I've thought about is the idea of this transgenerational epigenetic priming where, you know, grandma lived somewhere, you know, but it's like has these small changes that pass on to their kids, small changes. And then the whole idea of women passing on their microbiome to their kids through the perineal area. Like, could you talk to that a little bit? Because I think people hear these things like, oh my gosh, it doesn't matter. But literally just as like there's badness going on, there can be goodness going on and you can actually change this for the future, but it takes a little bit of work. Could you talk about the whole idea of this trend, whatever you want, whatever term you want to use about intergenerational changes?

Yeah. So you hit on a very important point, which is the inoculation of the gut microbiome. So during gestational period, the women's vaginal microbiome undergoes a significant shift, and it actually facilitates the growth of lactobacillus, and that's to inoculate the the infant. Now, we can go back and forth about the different studies, but generally the consensus is that the gut microbiome in gestation in utero is sterile. And so when the passage of the infant travels through the birth canal, this is the first. contact with the microbial environment. And that is why it's very important to have that contact with the Lactobacillus-rich microbiome. And what studies have shown is that infants born via C-section, and I believe the United States has a 30% rate, some countries in Latin America have a 50% rate of C-sections. What happens in those infants is they actually acquire the hospital microbiome. So the microbiome that's actually floating in the hospital ducts and in the air, and that is lacto— excuse me, that is Lactobacillus-deficient, Klebsiella-rich, and Klebsiella is dysbiotic. So those infants acquire immediately a dysbiotic gut.

So, you know, so what? We said all these things. Okay, great. We're all dysbiosis. We're all going to die. You know, so what? What? You know, I did this test and I'm doomed, right? What, what can be done? Because I think when people hear these podcasts and this messaging, what I'm excited about is using food like a drug and then using supplements to superpower that, which, you know, we adopted all of our kids, which my audience knows about that. And they've all— my son's eczema and horrible asthma went away after 6 months of us just changing his diet. You know, it's pretty powerful. So, so we talked about all the chemicals and telomeres and all this kind of stuff, and everybody's overwhelmed right now.

Absolutely.

I have no idea what to do. So, Dr. Julie, what do we do? What's, what on earth does the average person listening to this, what are the 3 major things they should do that would have the biggest impact on getting their mind pushing up that hill, the boulder up the hill with the most impact possible?

Well, I would say feeding the gut microbiome is probably one of the biggest things you can do because, you know, exactly as you mentioned, if we do miss that very first window of inoculation, The microbiome is a very modifiable risk factor that actually goes on to influence hormones, mitochondria, cardiac tissue. So it's, I mean, et cetera, your your bone density. So it's really important to modify via diet. That's a great factor. So with regards to the gut, I would mention greens, beans, and berries. Very simple, natural diet, traditional diet to support the gut microbiome. Nothing.

Gotcha. So obviously diet, real food, greens, beans, and berries. What else? What are 2 other things that people can do besides that to have an impact? Not supplements and other stuff, but just lifestyle things.

So actually exercise improves microbiome diversity, socialization as well. So when we are exposing ourselves to other people, when we're exposing ourselves to the environment outdoors, that does change our gut microbiome. So those little, those factors actually can make a difference.

Gotcha. So what kind of, so basic things. So I, one of the things I tell people is focus on the basics, perfect the basics, real food, real environment, healthy relationships, adequate sleep, stress reduction. So you're doing all that. What are the next, if you had a couple of like things that have the most data on them as far as feeding these keystone species, for example, which are the, those are probably the big levers you want to push on. Uh, what, what would be some supplementation things after you're eating real food, you're getting adequate sleep, um, you're exercising, moving, drinking adequate water, getting adequate fiber. Oh my gosh. That's like probably one of the most ridiculously important things. What are some supplements that you think could be helped push this?

Okay. So there's a few different ways you can go. I would say foundational supplements for the gut microbiome, vitamin D and turmeric. So making sure you maintain vitamin, uh, Optipen vitamin D. Status because that does improve tight barrier. It also improves mucosal integrity and diversity. The other thing I would say is turmeric. So turmeric is anti-inflammatory, it improves diversity, and it supports mucosal barrier integrity. Those would be the things that I would probably think of foundationally. Then I would think about probiotics because you can't introduce probiotics without having a secure and protected intestinal mucosal barrier. If you put probiotics into first, excuse me, you may, you run the risk of irritating the system and actually creating downstream sequelae. So that would be something to consider. And then a really quick one that I could add on is olive oil. Olive oil improves microbiome diversity. It supports those tight junctions and it's anti-inflammatory as well in the colon. And we know it has myriad of other effects on cardiovascular health, et cetera.

Yeah, I actually will make mayonnaise out of olive oil sometimes. It's olive oil is like one of those superfoods. That's, that's amazing what it does. A lot of my patients actually, they're more my SIBO patients. My sicker patients will react. You give them a probiotic and they have a horrible response to it. Like, why would that happen? And if that happens, what Yeah.

So that can happen if there is mucosal barrier integrity issues. So if the mucosal barrier is not intact, when you add the probiotic in, it's essentially an exogenous substance. And so there's a little, a little bit of an immune reaction there, a little bit of irritation and reaction. That's why it's really important to actually restore mucosal barrier primarily. Another factor is sometimes patients can have yeast and there can be an agitation there. But more often than not, it's actually mucosal barrier integrity issues.

Okay. That makes sense. Yeah, a lot of times in the SIBO world, people are like, it's purely a mast cell issue, or it's purely this or that. But the mucosal barrier makes sense because they, I mean, they must all have mucosal barrier biofilm issues, which if you don't address those, that can cause problems. Last but not least, testing. So Everybody loves testing. You know, what's your favorite testing for the gut microbiome, for the different aspects of it, and why?

I always go for the GI 360 test. You mentioned direct-to-consumer testing. Unfortunately, there is not a lot of regulation with direct-to-consumer tests. You know, patients are doing the best that they can and reaching for something, but those aren't— many times those are not validated platforms. So, GI 360 is third-party validated. The gut microbiome dysbiosis index has been published in over 40 peer-reviewed journal articles, so you're getting that information. You're getting diversity. You're getting information about parasites. You're getting information about fungal infections, dysbiotic bacteria, and then of course the important immune factors like fecal secretory IgA, lysozyme, the short-chain fatty acids, and some Digestion and absorption markers.

Not that I would ever recommend this on a podcast for thousands of people to listen to, but with the GI 360, which I— that's a great test. I've actually had patients that, not that I've recommended this, but have taken it, put it into AI tool and interrogated it. And one of them actually found that part of his— he had actually collagen colitis, which is a rare colitis I used to never see. Now I see all the time. It's just like It's like EOE, the things you never see that are everywhere. And he realized, he actually realized he had periodontal issues from the gut microbiome that actually were, you know, we fought, we swallowed 5 trillion bacteria a day, right? And so his mouth was seeding his gut. And the clue to it wasn't the dentist, and he sees functional people all up and down the East Coast, was actually the GI 360 that picked up certain abnormal species of bacteria that pointed towards his teeth and had to refer him back to his functional dentist. Who then was like, oops, you're right. And I did additional tests, but it was really kind of, it's, it's really, if you get in the weeds with the GI 360, gives you the basics, but it gives you a lot of stuff. If you want to go in the weeds, you can really, really go in the weeds and find a lot of interesting data points that, and then like, what foods do you eat to fix some of those abnormalities? That's really, really interesting.

Yeah. You can garner information about diet and, uh, the oral mucosa as well. So there's a lot of information in that test. Absolutely.

So, um, this is a great conversation. I wanna respect your time. Um, where, where can people learn more about you? Uh, what are you doing now? What are you doing next?

Um, yeah, great question. So actually you can find me as a staff doctor at Doctor's Data. You can also find me on Instagram at Dr. Julia Malkowski. And I do have a podcast called Modern Human that will be available on all podcast platforms in September.

Great. Thank you so much for your time. I really appreciate it. This is a great conversation. I feel like we hit like a bazillion topics. It was like, this is a lot of information. So, um, I think we ended up really great with the basics and some testing, which is amazing. So thank you so much for your time. I really appreciate it.

Thank you so much. I appreciate your time as well.